Tuesday, October 11, 2016

For Josh and John - use of interleukin-2....today....

As I've spoken about before, my very first oncologist looked at me 13 years ago with tears in his eyes and said, "Renal cell carcinoma and melanoma are the cancers I hate most."  As disconcerting as it was to hear, he had good reason for that opinion!  Until recently, patients with these cancers had very few effective treatment options.  Now, however, we are learning that immunotherapy can shine a light of hope for both.  My dear John being one of these peeps in urothelial cancer wold!!!  And as Joshie has experienced first hand...twice...IL-2 is an older drug in melanoma world that can provide durable responses, albeit for a small number of treated patients.  Now there is this:

Contemporary experience with high-dose interleukin-2 therapy and impact on survival in patients with metastatic melanoma and metastatic renal cell carcinoma.  Alva, Daniels, Wong, ... McDermott, Agarwala et al.  Cancer Immunol Immunother. 2016 Oct 6. 

High-dose interleukin-2 (HD IL-2) was approved for treatment of metastatic renal cell carcinoma (mRCC) in 1992 and for metastatic melanoma (mM) in 1998, in an era predating targeted therapies and immune checkpoint inhibitors. The PROCLAIMSM registry was established to collect and analyze data for patients treated with HD IL-2 in the current era. This analysis includes 170 patients with mM and 192 patients with mRCC treated between 2005 and 2012 with survival data current as of July 27, 2015. For patients with mM, complete response (CR) was observed in 5 %, partial response (PR) in 10 %, stable disease (SD) in 22 %, and 63 % had progressive disease (PD). The median overall survival (mOS) for these patients was 19.6 months, with a median follow-up of 43.1 months. The mOS was not reached for patients achieving CR or PR, and was 33.4 months for patients with SD. For patients with mRCC, 6 % achieved CR, 9 % had PR, 22 % had SD, and 62 % had PD. The mOS was 41 months, with a median follow-up of 46.6 months. The mOS for patients who had CR and PR was not reached and was 49.6 months for patients with SD. There were no treatment-related deaths among 362 patients. The duration of mOS for patients with mM and mRCC is longer than historically reported. These data support a continued role for IL-2 in the treatment of eligible patients with mM or mRCC and warrant further evaluation of HD IL-2 in combination or sequence with other therapeutic agents.

My hope is that IL-2 can be made much more useful when combined with TIL and/or immunotherapy as is already underway in current studies.  Hang in there ratties...of all stripes!!! love, c

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